Patient Survey

1100 Richmond Avenue, Unit B
Brandon R7A 1M6
Manitoba
Canada
Tel 204-726-1211
Fax 204-571-1560
Email Us

We want to hear from you!

As part of our continuing effort to provide the best quality periodontal care, we ask you to please take a few minutes to give us your thoughts.

Please choose the answer that best describes your feelings and experiences.

User Information

Name : Email Address :

Telephone Courtesy

Poor
Good
Excellent

Seen on Time

Yes
No

Scheduling Appointments

Poor
Good
Excellent

Friendliness

Poor
Good
Excellent

Care by Dr. Corbett

Poor
Good
Excellent

Care by Staff

Poor
Good
Excellent

Quality of Treatment

Poor
Good
Excellent

Was there anyone in our office that made your experience special or difficult

Yes
No

What did that person do?

What else could we do to improve a patient's experience in our office?

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